Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) in Young Children
Overview: The CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) is a behavioral
scale for evaluating postoperative pain in young children. It can be used to monitor the
effectiveness of interventions for reducing the pain and discomfort.
Patients:
• The initial study was done on children 1 to 5 years of age.
• It has been used in studies with adolescents but this may not be an appropriate
instrument for that age group.
• According to Mitchell (1999) it is intended for ages 0-4.
Parameter
Finding
cry
no cry
1
moaning
2
crying
2
screaming
3
smiling
0
composed
1
grimace
2
positive
0
none
1
complaints other than pain
1
pain complaints
2
both pain and non-pain complaints
2
neutral
1
shifting
2
tense
2
shivering
2
upright
2
restrained
2
not touching
1
reach
2
facial
child verbal
torso
touch
Points
legs
touch
2
grab
2
restrained
2
neutral
1
squirming kicking
2
drawn up tensed
2
standing
2
restrained
2
where:
• no cry: child is not crying
• moaning: child is moaning or quietly vocalizing silent cry
• crying: child is crying but the cry is gentle or whimpering
• screaming: child is in a full-lunged cry; sobbing may be scored with complaint or
without complaint
• smiling: score only if definite positive facial expression
• composed: neutral facial expression
• grimace: score only if definite negative facial expression
• positive (verbal): child makes any positive statement or talks about other things
without complaint
• none (verbal): child not talking
• complaints other than pain: child complains but not about pain ("I want to see
mommy: or "I am thirsty")
• pain complaints: child complains about pain
• both pain and non-pain complaints: child complains about pain and about other
things (e.g. It hurts; I want mommy. )
• neutral (torso): body (not limbs) is at rest; torso is inactive
• shifting: body is in motion in a shifting or serpentine fashion
• tense: body is arched or rigid
• shivering: body is shuddering or shaking involuntarily
• upright: child is in a vertical or upright position
• restrained: body is restrained
• not touching: child is not touching or grabbing at wound
• reach: child is reaching for but not touching wound
• touch: child is gently touching wound or wound area
• grab: child is grabbing vigorously at wound
• restrained: child's arms are restrained
• neutral (legs): legs may be in any position but are releaxed; includes gently
swimming
• squirming kicking: definitive uneasy or restless movements in the legs and/or
striking out with foot or feet
• drawn up tensed: legs tensed and/or pulled up tightly to body and kept there
• standing: standing crouching or kneeling
• restrained: child's legs are being held down
CHEOPS pain score = SUM(points for all 6 parameters)
Interpretation:
• minimum score: 4
• maximum score: 13
References:
Beyer JE McGrath PJ Berde CB. Discordance between self-report and behavioral
pain measures in children aged 3-7 years after surgery. J Pain Symptom Manage.
1990; 5: 350-356.
Jacobson SJ Kopecky EA et al. Randomised trial of oral morphine for painful
episodes of sickle-cell disease in children. Lancet. 1997; 350: 1358-1361.
McGrath PJ Johnson G et al. CHEOPS: A behavioral scale for rating postoperative
pain in children. Adv Pain Research Therapy. 1985; 9: 395-402.
McGrath PJ McAlpine L. Physiologic perspectives on pediatric pain. J Pediatr. 1993;
122: S2-S8.
Mitchell P. Understanding a young child's pain. Lancet. 1999; 354: 1708